Radiofrequency ablation or hepatic resection for microinvasive very early hepatocellular carcinoma

Intrahepatic disease recurrence is observed frequently after radical therapies for patients with very early hepatocellular carcinoma (HCC) (diameter <2 cm). However, the choice of therapy for very early (VE) HCC is still unclear. To clarify the indication for therapy for VE HCC tumors, the authors evaluated the results of hepatic resection (HR) and laparoscopic radiofrequency ablation (LRFA) in VE HCC patients with or without the presence of microinvasion (MI) defined as portal venous, hepatic vein, bile duct infiltration, and/or intrahepatic metastasis [1]. Methods: A retrospective review was undertaken of 192 patients with primary solitary VE HCC who underwent either HR or LRFA between 1997 and 2013. In this series, the presence or not of MI was detected by intraoperative ultrasound according to a personal classification already published [2]. Long-term results (survival and local recurrences) of patients with VE HCC accompanied by MI were compared to that of patients with HCC without MI and was analyzed on the basis of the different therapies. Results: Sixty-seven patients (35%) had HCC and MI (36% in LRFA and 33% in HR group). Actuarial survival rates of patients with VE HCC and MI (5 year 36%) were significantly worse than those for VE HCC without MI (5 year 64%) (p=0.0312). This disadvantage in the overall survival rate of patients with VE HCC and MI disappeared in the group submitted to HR (5 year 61%) instead to LRFA (5 year 22%; p=0.036). This finding could be secondary to higher rate of local recurrences in patients with VE HCC and MI after LRFA (34%) than in those without MI (17%; p=0.028). Patients submitted to HR showed no differences in local recurrences in cases of HCC with or without MI (8% vs 6%) Conclusions: Even in patients with VE HCC, intraoperative ultrasound is able to identify more aggressive forms of tumor with an incidence similar to pathologic examination. VE HCC with MI has a worse prognosis than VE HCC without MI: in cases of VE HCC with MI, HR is able to guarantee better overall survival rates than does LRFA, reducing the risk of local recurrences.